Creativist Society

Why we need to learn to see, not problem solve

“How would your department look if you came back from holiday?”

This was the question that James Wilk asked when he was called in to see if he could cut the number of surgical errors at Maimondes Medical Center in New York. Patrick Borgen, the chief surgeon, who turned to James Wilk for answers, expected him to start the same way as other management consultants, asking him to explain what the problem was.

But James Wilk’s approach meant that he asked Borgen to describe in fine detail what his department would look like if he came back from holiday. And, according to the article in the October issue of the UK edition of Wired magazine, two four-hour sessions later, the two men had answers. (The article is not currently online).

‘One element was geographical: over the years, surgeons had landed wherever there was office space. Borgen identified a hallway in the hospital and started by clustering six heart surgeons together on the same corridor. Wilk also proposed developing a protocol for handovers between anesthetists supervising an operation, and those on duty in the ward. Borgen taped a list of back-up surgeons, with their pager numbers and specialties, to the refrigerator in the common room. “It sounds simple,” admits Brogen, “but it immediately established a team culture”.

And the results? Within a year, surgical errors reduced tenfold and the hospital received a rating putting it in the top 5% of hospitals in the US. An estimated 20-30 lives have been saved.

James Wilk, as well as running Interchange Associates, a five-person think tank, is an Oxford philosophy don who teaches a course on Wittgenstein. Looking up Wittgenstein quotes, I can see where Wilk might get some of his inspiration for his approach. For example, Wittgenstein said ‘Don’t get involved in partial problems, but always take flight to where there is a free view over the whole single great problem, even if this view is still not a clear one.’

It seems to me that it was this free view that Wilk was unlocking with his question. He was inviting Borgen to look at his department as a whole, rather than focusing on specific problems.

If we can describe accurately what we see, as a totality, then what needs to change will become obvious. If we start with the problem, we are only going to get a better version of what we have already, we are already starting to define the boundaries of the solution. If we can start looking with precision and holistically, we are then free to look differently and for answers to emerge. And, sometimes, the answer will be simple, one that seems obvious in hindsight. And sometimes it will be radical. But the seeing will have opened up a new way of thinking. And the answer will be responding to the totality of the situation, rather than a fragment of it.  We need to learn to clear and open up the connection between our eyes and our mind.